Abstract
Despite well-documented and ubiquitous belief that connection to nature is essential to human well-being, both medical practitioners and patients experience suffering related to the impacts of lack of connection. Nonetheless, we believe the benefits of connection and a sense of kinship with wild nature are integral to the professional development and self-care of physicians, and we hope to encourage our students to consider this belief as well. At the juncture of these areas, a fourth-year medical student elective was developed for students to explore the fundamental ecopsychological and ecospiritual concerns for reconnection with nature and the broader implications for mental health in the context of alienation from the natural world. To consider how a nature intervention could both prepare medical students to manage their future work as physicians and prompt them to consider how their patients could benefit from like interventions, the purpose of this project was to evaluate the efficacy of the course and to examine the impact on students’ perceptions of nature and well-being of themselves and their patients. Participants enrolled in an M4 elective, including two nature immersions, completed pre- and post-course surveys, course writing assignments, and pre- and post-course creative surveys. The student responses demonstrated that students had positive reactions, increased learning, and altered behavioral intentions as a result of the course. This course could be easily replicated at other institutions or utilized to design development opportunities for students, faculty, or staff.
Introduction
From ancient times, the belief that connection to nature is essential to human well-being has been global, ubiquitous, and well-documented (Capaldi et al., 2015). Current planetary conditions have only exacerbated the already recognized crisis in mental and physical health—resulting from the separation of humans from the more-than-human-world (Thoma et al., 2021). Physicians recognize that climate has an impact not only on their clinical work but also on their own well-being as individuals (Armand et al., 2024); however, they also acknowledge a need for training to know how to respond to these challenges for themselves and their patients (Stryer et al., 2025). This is representative of a phenomenon called the “value-action” gap where those who report high concern for the impact of environment change may not be taking actions to ameliorate such concerns (Manley et al., 2024). This work investigates the preparation of medical students interacting with nature with the intention that it could both prepare them to manage their future work as physicians and also prompt them to consider how their patients may also benefit from like interventions.
Across generations and cultures, many have observed the importance of nature connection and have lamented our separation from nature. For example, Henry David Thoreau in his essay Walking, equates “Nature” with freedom and wildness, a Mother from whom humans were weaned too early—and prescribed a daily “saunter” in a forest to restore “health and spirits” (Thoreau, 1862). Marc Berman, founder of the emerging field of environmental neuroscience, has quantified through controlled experimentation the environmental features that affect our minds, bodies, and entire lives—and like Thoreau, encourages us to bring nature into our schools, homes, places of work, and our communities and offers nature prescriptions (Berman, 2025). In her poem “The First Water is the Body”—speaking of a wild native river—Natalie Diaz writes … “This is not a juxtaposition. Body and Water are not two unlike things—they are more than close together or side by side. They are same—body, being, energy, prayer, current, motion, medicine” (Diaz, 2020).
Despite the well-documented connection between nature connection and mental health, few therapeutic approaches have been developed and taught. One approach that has gained recent attention is nature prescription, in which providers’ write prescriptions directing patients to spend time in nature. Nature prescriptions are commonly prescribed for anxiety, depression, stress, and underactivity; however, both time and the infrastructure necessary to encourage use (e.g., electronic medical record integration and park partnerships) serve as constraints to their use (Stryer et al., 2025). While providers indicate their positive perceptions of efficacy (Stryer et al., 2025), there is not yet consistent or widespread enough use to robustly study their efficacy (Kondo et al., 2020). Despite the abundance of research demonstrating the beneficial effects that nature has on our cognitive, emotional, spiritual, and physical well-being, nature-based interventions are understudied and underutilized as a mental health strategy for patients or physicians.
In addition, there is evidence to support that medical practitioners are plagued both professionally by the impact of climate change on patients (Goshua et al., 2021) and personally by burnout and loss of connection (Vaa Stelling et al., 2023). But it is interesting to note that the research on benefits to care providers—specifically physicians who promote and prescribe time in nature for their patients—is sparse (Kondo et al., 2020). Providers who write nature prescriptions have been shown to take more breaks outside and have a greater connection to nature (Stryer et al., 2025), but still little is known about the directionality of this relationship and whether writing nature prescriptions also improves provider well-being. Nonetheless, we believe the benefits of connection and a sense of kinship with wild nature are integral to the professional development and self-care of physicians, and we hope to encourage our students to consider this belief as well.
One path to restoring connection to the more-than-human world is to learn from those whose paths have not been led so astray from this connection. For example, Indigenous poets and storytellers reveal aspects of kinship with the more-than-human world that can help us explore what it means to be a member of the earth community (Harjo, 2020). These voices are strikingly absent from ecopsychological literature. The poetry of Natalie Diaz, Cassandra Lopez, Joy Harjo, and others seamlessly blends Indigenous wisdom, kindred ecology, and social justice in ways that draw us to deeper kinship and healing. These poets offer perspectives that illuminate the roots of disparities in indigenous health care and have the possibility to contribute to the formation of caregivers through a greater sensitivity to planetary health concerns emerging from an ever-growing alienation from nature —particularly in mental health. Clinical ecopsychological research has found that Indigenous communities and persons—women in particular (and women across cultures)—are more vulnerable but also more resilient in the face of climate catastrophes because of strong connections with nature and with native lands (Thoma et al., 2021; Vecchio et al., 2022). Indigenous voices offer perspectives that can challenge and transform dominant institutional structures and attitudes that have supported and sustained social injustices and the ongoing destruction of the biosphere. These structures have created disparities in Indigenous populations; the “decolonization” of ecopsychology is considered as a step toward addressing these disparities as well as addressing the implications of “colonial” attitudes toward the earth.
Development of the course
At the juncture of these areas, a fourth-year medical student elective was developed for students to explore the fundamental ecopsychological and ecospiritual concerns for reconnection with nature and the broader implications for mental health in the context of planetary crisis and alienation from the natural world. Creighton University is a private Jesuit medical school with campuses in both the Southwestern and Midwestern regions of the United States. The mission of the School of Medicine is to improve the human condition with a diverse body of students, faculty, and staff who provide excellence in educating learners, health care professionals, and the public; advancing knowledge; and providing comprehensive patient care. Cura personalis or “care for the whole person” is a central tenet of the way the curriculum forms future physicians and how providers serve patients. With the inauguration of Creighton University School of Medicine (CUSOM)’s revised curriculum, the humanities became increasingly important to the ways in which medical education and professional identity formation take place for medical students. With this emphasis, elective courses were developed for both pre-clerkship (M1 and M2) and elective phase (M4) students.
The focus of this project is an M4 nonclinical elective titled “Kindred Healing: Ecopsychology, Ecospirituality, Indigenous Wisdom and Poetics of Place.” The course was four weeks in length and, importantly, included two nature immersion retreats for students. Within the course sessions, the emerging field of ecopsychology was explored through professional research and writing, Indigenous wisdom, ecopoetry, immersion in nature, the students’ creative and contemplative work, and the development of ecotherapeutic interventions and methods. The primary purpose and overarching theme of this course was the enhanced ability to understand and address mental and physical health issues related to environmental anxiety and alienation from nature and to explore and develop ecopsychological therapies and approaches with special sensitivity to patients from marginalized communities.
In this course we paid close attention to the needs of members of Indigenous communities as well as drew upon the wisdom of these communities. Andy Fisher’s article “Ecopsychology as Decolonial Praxis” (Fisher, 2019) was included in course materials and sparked lively conversation. Postcolonial Love Poem, a collection of poems by Natalie Diaz, was required for this course, along with the works of other native poets—primarily women (Diaz, 2020). However, wild nature was the primary text and teacher. The Creighton University Retreat Center and other nearby nature preserves offer wild habitats to explore. This course weaved together immersion in wild silences in wild and native ecosystems of our region, foundational principles in ecopsychology, Indigenous perspectives revealed in ecopoetry, as well as our own acts of creativity and growing sense of kinship that emerge in the woods. The framework of reciprocity grounds this course, as the theme of “Kindred Healing” was central. Growing intimacy with nature naturally results in enhanced feelings of mutual care—that the healing of self, community, and Earth are deeply connected.
Our course expressed the “second wave” of ecopsychology that can be characterized, according to Andy Fisher and Peter Kahn, as an “integrative praxis” that turns “psychology inside-out” by liberating the concept of psyche from a purely “individualized interior” into fields of interrelationships that include both human and more-than-human communities (Fisher, 2019; Coope, 2019). For many ecopsychologists, indigenous wisdom grounds and centers this “liberation” in both theory and practice. In addition to the grounding and centering the “liberation of psyche and interiorized self” articulated by Fisher, we also explored the indigenous values of immersive kinship, creativity, and reciprocity as expressed in the course readings in a variety of poetic, theoretical, clinical, and cultural contexts. The poetry of the indigenous women mentioned above—in both content and form—conveys these values in clear and compelling ways and inspires students to find their authentic poetic voice. These values formed the framework for the students’ written work and provided the agenda for the retreats they were required to design and lead for their professors and peers. (See the Supplementary Appendix with the appended syllabus for more details.) Always mindful of the risks of cultural appropriation, we nonetheless sought to embrace and embody these values as creatures indigenous to the Earth (Perluss, 2012; Reinders, 2017).
The one-day outdoor retreats began with “grounding and centering” that included yoga-based movement designed to open the body to wild nature and connection with the Earth and to quiet the mind. This was followed by an immersive prompt that was intended to lead into a deepened awareness of wild kinship through a period of quiet hiking or inhabiting a “sit-spot.” A basic template and examples were drawn from a variety of recommended texts, from prompts created by previous students, and from The Naturalist School (TNS), a collaborating nature connection nonprofit. (J.P., course director and instructor, is the principal of TNS.) After the immersive prompt, creative activity expressed this awareness in poetry, free-writing, drawing, building ephemeral sculptures, or other artistic forms. For the final retreat at the end of the course designed and facilitated by the students, original prompts and activities of their own creation provided the content and agenda for the day.
The retreat day culminated in acts of reciprocity in which kinship and gratitude are translated into action. The nature preserves that provide the location for our retreat days are also conservation partners. For example, we have collected seeds, planted trees, and engaged in bird and other biotic surveys that provide important data for land management and ecological research. Our retreat days often include faculty from the Creighton University Biology Department. Birding has been shown to have positive mental health benefits as well as contribute to citizen science (Andrews et al., 2025), and several of our students have become avid birders. But perhaps the most basic and impactful form of reciprocity is the deep realization of kinship, awareness, compassion, and devotion to our earthly kin in human and more-than-human forms and presences.
One might observe that the retreat days resemble “forest-bathing” and “forest therapy” practices that have become popular, but our practice may differ in that it emphasizes structured movement, artistic creativity, and reciprocity as integral to the immersive experience. The retreat structure and content used in this course—as well as the prompts and other activities designed by the students—have become the basis for ongoing noncredit retreats for medical school faculty, staff, and students.
Students developed their own creative writing and activity prompts around themes of how deeper connections with nature can contribute to their formation as physicians and to the mental and physical health of their patients. These prompts developed by fourth-year medical students land squarely within the practice of “nature prescription.” Each student was required to write a series of creative and prescriptive prompts that are intended to help patients and colleagues connect more deeply with nature. These included creative writing, nature contemplation and meditation, and “scavenger hunts” that engage the senses to find shapes, patterns, colors, tactile experiences, smells, or other sensate phenomena. Students found birding prompts useful in unstructured (self-directed bird hikes) and structured activities such as learning identification and mindful birding exercises.
This structured “prescriptive prompt” approach is supported by research that has found health benefits in both structured and unstructured activities (Kondo et al., 2020). In a culture that finds Americans increasingly connected to digital media, smartphones, and computer screens and disconnected from the other-than-human world, many patients benefit from being given a directed immersive task to help them unplug from “sedentary and screen-based lifestyles” and to “plug in” to nature; this structure helps to guide participants’ time spent on meaningful activities. The course culminated in a one-day retreat designed by the students for School of Medicine students and faculty that includes both structured and unstructured activities.
Overall, this course was intended to help physicians in training understand the mental health implications of what ecopsychologists call alienation from nature and how experiences in nature (the world of other-than-human living things in a natural habitat) can improve mental and physical health. Moreover, this understanding can help caregivers develop therapies and connect more deeply with patients as members of an ever-changing and threatened planetary system. See Table 1 for stated course learning objectives.
Course Learning Objectives
Current research: evaluation of course
The purpose of this project was to evaluate the efficacy of the course and to examine the impact on student perceptions of nature and well-being of themselves and patients. The Association of American Medical Colleges (AAMC) has recognized, both in a scoping review and in their report on “The Fundamental Role of the Arts and Humanities in Medical Education,” a specific need for more rigorous research and evaluation of outcomes in medical education innovations related to the arts and humanities (Moniz et al., 2021; Howley et al., 2020). One evaluation of a five-day mini course for medical and dental students reported positive satisfaction and increased self-reported attention, mindfulness, creativity, and connection to the natural world (Trudel et al., 2024). Similar to our work, this was limited to a single experience at a single institution; the current research will explore similar outcomes in hopes of corroborating the results. Consistent with the Kirkpatrick model of program evaluation (Kirkpatrick, 1959), inquiries focused on (a) students’ perception of the course (reaction), (b) students’ attainment of learning objectives (both stated and unstated; learning), and (c) students’ personal and professional identity development as related to their behavioral intentions as a person and future physicians (behavior). It was hypothesized that the course, including two nature immersions, would change the way fourth-year medical students think about themselves both as individuals and as future physicians, particularly in the context of nature and well-being. In addition, we hope that this project can result in a model of integrating this curricular content for other institutions with similar aspirations.
Materials and Methods
Participants were six fourth-year medical students; each student was enrolled in one of two course offerings of the elective during spring of 2025. All materials included in the research were collected from activities and assignments from the course. No additional demographics were collected due to the small size of the sample and possibility of inadvertently identifying individuals in the data based on participant demographics.
Pre- and post-course surveys
A survey was developed to examine changes in beliefs about the nature-wellness connection (Connectedness to Nature Scale; Mayer and Frantz, 2004) and to examine how the course influenced students’ future behavioral intentions for nature exposure and introducing nature exposure to their patients. The survey utilized both quantitative and qualitative questions.
Course writing assignments
Students completed writing prompts during each week of the course. For the purposes of this research, the final writing prompt was included. The students were asked to provide a brief summary of ecopsychological therapies or interventions presented in this course and how these can contribute to the healing arts, patient care, and your development as a physician.
Pre- and post-course creative surveys
On the first meeting and last meeting of the course, students were provided a large sheet of paper and oil pastels and asked to write a heading: “What is Nature” and to draw a response without using words. A second prompt was introduced with the heading “Who Am I.” During the last session, students additionally made a mural together on a larger sheet of paper that expresses their experiences of nature connection during the rotation. These assignments were collected to provide additional narrative context for how the course impacted students.
Analysis
The quantitative questions from the survey were analyzed using a series of paired-sample t-tests to determine if there were differences between the pre- and post-survey administrations. Qualitative responses and drawing were reviewed by members of the research team independently; each was responsible for noting a set of observations from the written responses and drawings. The research team then met to review their observations and identified their common observations through discussion. Together the team then identified representative comments to illustrate general themes from the responses. The limited number of participants limited the ability to use a more robust thematic analysis strategy. This study was classified as exempt by the Creighton University Institutional Review Board (IRB#2005453-01). Participants provided consent to participate as well as permission for their poems and drawing to be shared in publications.
Results
Pre- and post-course surveys
Items from the Connectedness to Nature Scale provided evidence of acceptable reliability (pre-survey: α = 0.91; post-survey: α = 0.85), slightly higher than that in the original reliability analysis of the instrument (α = 0.79–0.84; Mayer and Frantz, 2004), so a composite score was computed. The remaining items were assessed individually. A series of paired-sample t-tests were conducted to test for differences in pre- and post-survey quantitative responses. In all cases, there were significant differences in student responses from pre-survey to post-survey, t = 2.66–4.53, p < 0.05 (See Table 2); all tests demonstrated large effect sizes (Cohen’s d = 1.09–1.85).
Pre- and Post-Survey Scores for Each Measure/Item
When prompted to describe nature before the course, students remarked on the physical items and beings that occur in nature. One student described, “Nature is the place where birds sing, not drown out by traffic noise, where all kinds of flowers, brushes and trees grow and animals, like the deer, bunnies, bear, wolf live in their shade as the nearby river rushes through the rocky cavern.” When prompted to describe nature after the course, students remarked on the wholeness and ubiquitousness of nature. One student remarked, “Nature is part if every being and object. There is a connectedness between all things because of nature. Nature changes rapidly through time and space but also remains the same. It’s the core of everything living!”
When asked about what they would change about their personal practices as a result of the course, students all remarked about spending more time in nature, and most remarked about how the course had highlighted or reinforced the link to the value of nature to their well-being or mental health. One student commented, “I am going to prioritize nature and my connectedness to it. Entering the course, I knew nature played a big role in my mental health and I was very aware that I needed it. However, this course has taught me to prioritize me and make a daily effort to incorporate nature into my life and future practice.”
When asked about what they would change about the way they interact with patients as a result of the course, students all talked about speaking with their patients about the value of nature but described many different means by which to do so. Examples included:
“Young people are getting outside less and less. After taking this course, my belief is renewed in being outside, especially as children. This is something I intend to bring up often in the clinic when screen time comes up.” “On inpatient services I will definitely encourage ambulatory patients to spend time outside and in the healing gardens.” “I will be more quick to talk about the benefits of the outdoors when talking about lifestyle and talks to patients about nature. I also will be more mindful of the environmental destruction being tied to indigenous wounds.”
Course writing assignments
In the writing assignment about ecological therapies, students remarked on how much the course content had added to their learning and how they had personally benefitted (e.g., opening eyes to research, understanding the impact of climate on health). Beyond this basic understanding of learning related to course objectives, there was a recognition for the value of this content in developing the students as healers. One student remarked, “Kinship of earth and body goes against the “rational” and “evidenced-based” rhetoric of the medicine community, but I need to know it to be a healer.” Another student commented that “We need to rebuild the interconnectedness with the world around us so that we can build a greater sense of empathy and gratitude for it. Without this connection, it becomes too easy to continue to do harm.”
When describing future strategies for working with patients, all students again endorsed the use of strategies but offered a variety of different approaches:
“Overall, this class has expanded my idea of what we can provide and encourage for our patients so that they may reach a higher sense of well-being.” “As a child nature was my teacher, so it’s personal to want my future pediatric patients to experience the same. For my adult patients, who are merely children in a bigger damaged body, I want you to remember the wonder of childhood and heal the wounds. I know nature can help us.” “Promoting the decoration of the hospital’s internal environment to mimic the natural world may provide some benefit to the mental and emotional well-being of the child. The next step would be to promote external peace gardens or greenspaces that the child could visit while under medical supervision.” “Our practice in writing prompts for nature connection can be useful in giving patient’s a sort of “homework” that can be done on their own.” “As a doctor, I think that discussing access to nature is just as important as asking about a patients’ social history. To me, it seems worthwhile to have a simple conversation about encouraging nature-based activities, such as hiking, gardening, or just spending time outdoors.”
Pre- and post-course creative surveys
In response to the prompt “What is Nature?,” students’ post-course drawings were more likely to include a representation of themselves or humans central to the picture and actively engaging in nature (e.g., planting trees; Fig. 1). Representations of humans in the pre-course drawings tended to be smaller and did not include the human representation engaged in the activities of the picture. In addition, the post-course drawings depicted more inclusive and expansive representations of nature than the first drawing of the course. The pre-course drawings included plants or trees, while the post-course pictures depicted more integrated ecosystems including animals and water. We understood this to mean the students gained an understanding of nature as more complex and that humans are integral to the earth community. It was also noteworthy that the color palette after the course was more expansive, integrating more warm and bright colors; additionally, many students integrated motion in their representations in some way.
Example pre-course creative surveys.
In response to the prompt “What is Nature?,” students’ post-course drawings were more likely to include an organizational structure or perceived ecosystem; many drawings also included some form of abstract representation in the center of the drawing (e.g., dark-colored circle; Fig. 2). In addition, post-survey drawings included more abstract, expressive, and open or mysterious presentations. We understood this to mean that while the course helped students to center or organize their self-concept, it also opened additional questions or beliefs that could be explored through further identity development.
Example post-course creative surveys.
Discussion
The multimodal approach to evaluation allowed for the corroboration of evidence around different levels of the Kirkpatrick model of program evaluation (Kirkpatrick, 1959). That said, the small sample size should be considered when reflecting on the interpretation and generalization of these results; the following summary of results is reflective of the sample from this study. Overall, responses to various methods used in the research demonstrated that students appreciated the course and the course content (reaction). Students also demonstrated mastery of the course objectives and learning that expanded beyond the scope of the course objectives (learning). Similar to Trudel et al. (2024), in addition to their course satisfaction, students reported multiple aspects of personal growth as a result of the course. Specifically, students’ perceived connection to nature, understanding of nature’s relationship to health improved and understanding of Indigenous communities improved after the course; all quantitative items showed significantly higher scores on the post-survey than the pre-survey.
In the final writing assignment, students described both demonstrated growth on the course objectives that occurred during the course and increased awareness of how they are developing as healers and future physicians through the experiences of the course. In addition, the creative surveys and compositions demonstrated changes in students’ perceptions of nature and self-concept. Students demonstrated an increased understanding of nature as more ubiquitous and inclusive than they did prior to the course but also acknowledged that there was much more to study and learn. In addition, the creative surveys showed that students viewed themselves as more central in nature after the course.
These changes in self-understanding and, indeed, of the concept of the “self” exemplify what Fisher identifies as “integrative praxis” (Fisher, 2019) and an expanded view of the self that centers the person—and in this case, the physician—within a community of kinship with other-than-human beings. The students’ willingness and eagerness to read and discuss Native American “kinship” poetry and indeed to write their own poetry in this vein was striking and surprising and further demonstrates an expanded self-understanding. Within the practice of ecopsychology, both Perluss (2012) and Reinders (2017) have observed that poetic expression arises from a deep sense of kinship and intimate reciprocity with the Earth community; perhaps it should come as no surprise that it arose in our own students so vividly. For indigenous peoples, poetry is a natural expression of deep connection, that the earth is alive, that words are alive, and that language—especially poetry—has the power to create and heal within the context of community (Harjo, 2020). The more inclusive and expanded understanding of nature and creativity was encouraging, as it may expand the ways these future physicians seek out nature interventions for both themselves and their patients. In addition, it may help to identify way to make nature more accessible in their work and living spaces.
Finally, students’ self-reported confidence in speaking to patients about nature improved after the course (from X = 3.33 on the pre-course survey to X = 4.67 on the post-course survey). Narrative responses suggest students were impacted positively by the course and will use it to inform their choices of future self- and patient- care (behavioral intention). In the final writing assignment for the course, students described a variety of ways that they intend to engage their patients about conversations related to nature and their experiences with nature. It is noteworthy that while all students indicated an intention to utilize nature in the care of others, the variability of strategies students described was quite striking (e.g., patient discussions, physical clinical environment, recommending writing prompts). This variability illustrates that the course reached students in diverse ways, and rather than providing a single solution, the course promoted a creative process to find ways to integrate nature into specific settings and in unique ways to reach the same goal of nature exposure in the practice of medicine.
It is noteworthy that the written reflections from students all indicated a generally positive sentiment toward the course. While the students did not provide written feedback about improvements they’d like to see, they did provide verbal feedback to the course director (J.P.). Students requested that this content be available to them earlier in their medical experience and more often than in a single elective. In addition, students also expressed an interest in having a green space for instruction either on or closer to campus, as this would provide additional opportunities to integrate practices from the class for themselves and their peers.
This course offers a response to Maddock and Razani’s (2024) recommendations for maturing the field of nature connection as a health intervention and the AAMC’s recommendations for more rigorous research and evaluation of these innovations in medical education (Moniz et al., 2021; Howley et al., 2020). Specifically, we hope this course provides ideas to other faculty and institutions for how to educate the next generation of scientists and practitioners using wild nature. Our pilot course proved to be relevant to our nascent physicians and has become a regular course offering. Moreover, this M4 elective goes beyond the scope and duration of the month-long rotation because the students taking this course are required to design and facilitate a nature connection retreat for classmates and faculty, and noncredit retreats based on our course model have been replicated and offered to faculty, students, and staff for CUSOM’s Omaha and Phoenix campuses. Perhaps the most far-reaching impact of this course will be the experience of the student–physicians as they learn the therapeutic value of nature connection through their own deepening connections to nature and how these will shape their relationships to their patients and the interventions and prescriptions they have developed as a result.
Limitations
The study was limited by having small sample size at a single institution. In addition, more participants would have allowed for more robust qualitative analysis. As is true in most program evaluation research, we were limited in drawing conclusions about causality of relationships and limited in our ability to change attributes of the course to provide a better methodological design. We used multiple measures to triangulate data from multiple sources despite these limitations. In addition, the electives are self-selected by students from a large list of available options, and it is likely that students who enrolled in the elective had more motivation and interest in the topic than those who did not. That said, the pre-survey measures showed scores around the midpoint of the five-point scale, suggesting that students’ self-assessments and knowledge were not positively skewed even if they did self-select into the course.
Future directions
This elective continues to be offered to M4 medical students as an elective. Similar retreats have been offered as an optional activity for other students, faculty, administrators, and staff. Future research should compare the impact of the retreats on these groups. In addition, this work is being integrated into and informing the planetary health strategic plan at Creighton University School of Medicine. Finally, one of the authors (J.P.) is engaged with the Nature and Health Alliance; this group is collaborating to aid other schools’ similar types of work. Future research should continue to follow the impacts of this work across multiple institutions.
Conclusions
The student responses demonstrated that students had positive reactions, increased learning, and altered behavioral intentions as a result of the course in this particular context. This course assignments and activities could be easily replicated at other institutions or utilized to design development opportunities for students, faculty, or staff. Students were asked to compose a reflective work of poetry or creative prose. The composition was written during the rotation and during a time in nature. In closing, we share (with their permission) the power of this course through their words.
I can be still?
Earth itself always moves
quakes, cracks
What is still?
For all things move
even in death
the enzymes to break
down body move
What is still?
Perhaps it is not a word
that has truth
but a state of
conscious being
For nothing is ever still.
The sound of the birds
The pileated calls out
Thrilled for the company
Invader, Investor, Interested soul
Intentions is seeks and actions it knows
The chickadee speaks her name
The titmouse plays the imitation game
To my ears encoded
A language I am not meant to learn
Before the grass turns green,
the world begins to hum,
a gentle chorus rising from the earth.
The birds call out,
their voices stitching the air,
and frogs croak in the stillness,
their song bright beneath the grey sky.
Wind stirs the branches,
its whispers curling through the trees,
while water no longer frozen,
rushes over stones that have waited.
Beneath my feet,
the soft forest floor sighs,
a bed of leaves and earth,
warmth trickling through
as nature breathes again—
life returning,
even before the green.
Pounding.
Pounding, of my heart, my feet,
my ears
through a path of leaves and dirt
my belly aches
whispering of pounding past
First fast then slow
Fast again
Pounding on
the threshold between blinding sun | and sanity
Opulent rays piercing through
Sleeping branches
Mad with pain, glory
death and newness
Pounding on my ancestors
dust, leaves, sun, decay
Harmonies of birds
Pounding on ear drums
A sound so sweet it feels insane
The rhythm of our world
pounding deep within
Authors’ Contributions
C.A.E. served as coinvestigator on the project and lead the development of methodology, data curation, and analysis. J.P. served as co-investigator on the project and was responsible for the initial conceptualization of the project. All authors contributed to revisions and editing the article. All authors read and approved the final article.
Footnotes
Acknowledgments
The authors would like to thank the medical students whose educational data were used in this study. We also appreciate their consent to provide their written work as the concluding words of the article.
Author Disclosure Statement
The authors have no disclosures to make.
Funding Information
No funding was received for this article.
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References
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